An estimated 40,000 men and women worked at Ground Zero, the former site of the World Trade Center WTC) in New York City, and at the Staten Island landfill, the principal wreckage depository (Levin et al., 2004). Firefighters, law enforcement officers, paramedics, construction workers, utility workers, volunteers, and others carried out rescue-and-recovery operations, restored essential services, cleaned up massive amounts of debris and, in a time period far shorter than anticipated, deconstructed and removed remains of buildings. Workers were exposed to a complex mix of toxic chemicals and extreme psychological trauma that varied over time and by location (Landrigan et al., 2004; Lioy et al., 2002). Data from the monitoring and screening programs are aggregated by a Data Coordination Center and a recent report found that WTC responders had exposure-related increases in respiratory symptoms and PFT abnormalities that were persistent up to 2.5 years after the attacks. Sixty-nine percent of the first 9,442 responders reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination n 59%.The Specific aims of the proposed study include the following: 1) To provide comprehensive health monitoring and treatment services for World Trade Center (WTC)-related conditions in WTC responders, including out-patient and, when needed, in-patient treatment, through participation in a coordinated network of clinical facilities; 2)To identify, implement, evaluate, and revise as needed, appropriate protocols, procedures, and outcomes for treatment of WTC-related health conditions, using best available evidence from all relevant WTC responder clinical and research programs; 3) To characterize the evolution of WTC- related health conditions, including the detection of new health conditions, among WTC responders; 4) To assist WTC responders and their families to secure health benefits, workers' compensation and other appropriate services; 5) To engage in bi-directional communication of program results: a) to provide individual health and other monitoring and treatment program data to the WTC Data Coordination Center for aggregation and analysis, and b) to disseminate program results to WTC responders, other relevant parties, and the general public. It is anticipated that this study will improve the health status of these individuals in terms of acute and chronic health effects, as well as providing a frame work to improve the health of all people who respond to disasters. [unreadable] [unreadable] [unreadable] [unreadable]